PTSD Raises Suicide Risk In Major Depression

Patients with a major depressive episode and posttraumatic stress disorder (PTSD) make substantially more suicide attempts than those with depression alone, according to data from a new study reported in the March American Journal of Psychiatry.

“Patients with at least one major depressive episode who have or have had PTSD were significantly at greater risk of suicide attempts than patients with a major depressive episode and no PTSD,” said lead author Maria Oquendo, M.D., in an interview with Psychiatric News.

She is an associate clinical professor of psychiatry and clinical director of neuroscience studies at Columbia University College of Physicians and Surgeons.

In addition, women with a major depressive episode and PTSD had significantly higher rates of suicide attempts than men with a major depressive episode and PTSD, said Oquendo.

“In our study, more women than men reported physical or sexual abuse as children, which predisposed them to developing PTSD,” said Oquendo. One-third of people who report childhood abuse or neglect develop PTSD, and the presence of childhood abuse doubles the odds of developing major depression, according to the report.

A total of 156 male and female inpatients at the New York State Psychiatric Institute diagnosed with one or more major depressive episodes were assessed for PTSD, suicidal behavior, and clinical risk factors for suicidal acts between 1995 and 2000.

The greater rate of suicide attempts among patients with comorbid PTSD and a major depressive episode was not due to differences in substance abuse, childhood abuse, or cluster B personality disorders, stated the authors.

“When I asked my research subjects about a history of trauma or PTSD, many of them told me that I was the first clinician to ask that question. I would urge clinicians to routinely ask their depressed patients about trauma, which is frequently comorbid with depression. Otherwise, we may underestimate their risk of suicidal behavior,” said Oquendo.

The study, “Association of Comorbid Posttraumatic Stress Disorder and Major Depression With Greater Risk of Suicidal Behavior,” is posted on the Web at http://ajp.psychiatryonline.org/cgi/content/full/160/3/580. ▪

Am J Psychiatry 2003 160 580